Research Paper
The impact of gender on medical visit communication and patient satisfaction within the Japanese primary care context

https://doi.org/10.1016/j.pec.2017.08.001Get rights and content

Highlights

  • Female concordant visits showed higher levels of patient-centeredness than all other gender combinations.

  • Female physicians substantially modified their communication based on patient gender while male physicians did not.

  • Gender concordance was associated with higher female, but lower male patient satisfaction and relative to gender discordant visits.

Abstract

Objective

This study was designed to address significant gaps in the predominantly western-centric research literature by examining the influence of gender concordance in medical communication and patient satisfaction within the Japanese context.

Methods

New primary care patients (54 male and 49 female) were randomly assigned to study internists (6 males and 5 females). Recorded visits were coded with the Roter Interaction Analysis System (RIAS). Post-visit, patients completed a Japanese version of the Medical Interview Satisfaction Scale (MISS).  

Results

Female concordant visits showed higher levels of patient-centeredness than all other gender combinations. Female physicians substantially modified their communication based on patient gender while male physicians did not. Gender concordance was associated with higher female, but lower male patient satisfaction relative to gender discordant visits.

Conclusion

Contrary to normative experience of medicine as a male dominated profession in Japan, and gender-based power differentials, male-gendered clinical communication is less likely to satisfy male than female patients, while female-gendered communication is positively associated with female patient satisfaction.

Practice implications

Patient satisfaction ratings reflect greater gender flexibility in terms of acceptable physician behavior than Japanese norms would suggest.

Introduction

While numerous studies have linked physician gender to communication style, few of these studies have been conducted outside of western medical contexts. The conclusions drawn from the western studies are robust; female physicians communicate differently with their patients than their male counterparts. They spend more time with their patients, more frequently ask about and address psychosocial issues, explicitly respond to patients’ emotions, are more positive, both verbally and non-verbally, and more actively elicit patient disclosures in the medical dialogue [1], [2], [3], [4], [5]. Physician gender also has a significant influence on patient communication; patients of female physicians, both male and female, speak more overall, disclose more biomedical and psychosocial information, and make more positive statements than they do when with male physicians [3]. A synthesis of this research concludes that female physicians and their patients engage in communication that can be more broadly conceptualized as patient-centered than their male colleagues [4]. Furthermore, gender concordance may strengthen these communication effects; a systematic review found that medical visits of female concordant physician-patient dyads are more patient-centered than all other gender combinations [5].

This literature largely reflects western medical settings and little is known about whether the gender-linked communication styles described would generalize to the Japanese medical context. A recent study conducted by Noro and colleagues [6] examining the impact of medical student gender on communication during the course of an Objective Structured Clinical Examination (OSCE) suggests that it might. The study findings largely replicated gender-linked communication patterns reported in the published literature; however, since all of the simulated patients in the study were female, it was impossible to disentangle the communication differences found between male and female medical students from effects of gender concordance on communication. This is an important question as there is reason to speculate that gender concordance or discordance may play a significant role in guiding professional and social role expectations.

Although not focused on physician gender, another study conducted within the context of Japanese medical visits is relevant. Ishikawa and colleagues [7] observed 140 patients and their physicians at the National Cancer Center Hospital in Tokyo to describe visit communication and its relationship to patient satisfaction. The authors concluded that the communication patterns observed were largely consistent with those described in western studies. Patient satisfaction was positively related to physician use of open-ended questions and negatively related to physician directions, as found in western studies. However, additional findings were not consistent with the literature; patient satisfaction was inversely related to physicians’ emotional responsiveness and unrelated to physician verbal dominance, discussion of psychosocial topics or overall patient-centeredness [7]. Since 11 of the 12 study physicians were male, it was not known if the study findings would generalize to patient satisfaction with female physicians.

The well-documented Japanese “gender gap” reflected in substantially fewer women in political, social or economic leadership positions in Japan relative to the US and Europe [8], and Japan’s rating in the lowest quartile of countries worldwide on measures of gender equity [9], suggests that women may defer to males when performing professional roles. This is particular relevant in the practice of medicine; Japan has the lowest level of female participation in the physician workforce among all countries surveyed by the Organization for Economic Co-operation and Development [10].

The current study was developed to address the gap in the predominantly western-centric research literature on gender effects in medical communication by examining the role of gender and gender concordance on medical communication within the context of Japanese primary care visits. Considering both the broad research literature on gender-linked communication in medicine and the position of women within the Japanese societal context, we propose 4 hypotheses: (1) Female physicians communicate in a more patient-centered manner, including greater emotional responsiveness, facilitation and partnership, psychosocial questioning and counseling, and positive talk with their patients than their male counterparts; (2) Higher levels of patient-centeredness will be found in female concordant visits than in visits that include a male patient or physician; (3) Considering communication in gender concordant dyads as indicative of a gendered style, female physicians will modify their communication style when with male patients more than male physicians will modify their style when with a female patient; (4) Patient satisfaction will not differ by physician gender, but will be higher in gender concordant rather than discordant dyads.

Section snippets

Participants and settings

This study was conducted between April 2009 and October 2010. All 11 internists (5 female and 6 male) who work at the four Tokyo institutions (the Jikei University School of Medicine, Nomura Hospital, Oji Co-op Hospital and Seikyo Ukima Clinic) recruited to the study agreed to participate. A total of 156 new patients were recruited to the study and 116 (74%) consented to participate. Forty patients refused participation because they were feeling ill, were reluctant to fill out questionnaires or

Physician and patient characteristics

The five participating female physicians were some 10 years younger than their six male counterparts, (37.6 years; range: 30–49 years) vs (47.0 years: range: 30–65 years), however, the difference was not statistically significant (t = 1.2; P > .2).

Of the 116 consented patients, 103 were included in the final analysis; 13 patients were excluded due to poor recording quality (n = 2), incomplete answers to the satisfaction questionnaire (n = 8), or because an accompanying person dominated the dialogue (n = 3).

Discussion

We explored the nature and consequence of patient and physician gender concordance on primary care visit communication and patient satisfaction through the positing of four hypotheses. Our first hypothesis, female physicians would communicate in a more patient-centered manner than their male counterparts, was partially supported. We found a somewhat weak pattern of overall differences in the communication of male and female physicians; while female physicians were significantly less verbally

Acknowledgement

This work was supported by the Grant-in-Aid for Scientific Research (C) of the Ministry of Education, Culture, Sports, Science and Technology, Japan. Grant number: 21590714.

References (17)

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